CMS has revised a booklet that explains the Advance Beneficiary Notice of Noncoverage(ABN) Form. An ABN is a standardized form that health care providers must give Medicare beneficiary when the provider believes that Medicare may not pay for an item or service. The ABN is given to the patient prior to providing the service and the provider’s claim must denote that the ABN was given.
Read Full Post | Comments Off on New CMS ABN Booklet Available
While clinician skill and manner are important to a good medical practice, the author outlines the key attributes of a great practice: a solid clinician/practice manager team; consistent and continuous performance measurement; operational excellence and oversight; staff cultivation and management; and embracing change.
Read Full Post | Comments Off on What We’re Reading – What Makes a Practice Great?
CMS is launching the Electronic Submission of Medical Documentation (esMD) pilot project for providers to submit medical documentation in electronic fashion when responding to requests from Recovery Audit Contractors. The new system is expected “to reduce provider costs and cycle time by minimizing and eventually eliminating paper processing and mailing of medical documentation to review contractors. A secondary goal of esMD is to reduce costs and time at review contractors.”
Read Full Post | Comments Off on What We’re Reading – Medicare Pilot Project for Electronic Submission of Medical Documentation
Over the years, we’ve seen it all when it comes to physician documentation. One physician in a group insisted that if she wrote all the conditions on one line, they were connected. Her partner’s charting habit was using slash marks between the conditions, stating this implied a causal relationship between the diagnoses. Breaking them of these idiosyncrasies took some work!
We all know that diabetes can sometimes cause other conditions, from eye problems to kidney disease. Sometimes these conditions are unrelated to the underlying diabetes; more often than not, however, the diabetes actually caused these issues. It’s important that clinician documentation bear out the connection with actual words.
Documenting “CKD III secondary to Type II Diabetes” isn’t the same as charting “DM/CKD” or ‘DMII, retinopathy.’ Words such as ‘due to,’ ‘secondary to (or using the 2o),’ ‘caused by’ or even ‘with’ are all handy (and required) in conveying a causal relationship between conditions. Not only is this accurate charting of the patient’s diagnoses, but it makes a difference to the practice’s reimbursement under risk adjustment.
The use of electronic health records will help providers to chart more accurately because the systems are not able to handle creative documentation, but growing pains will be significant and reimbursement could suffer if your clinicians aren’t writing properly right now.
Read Full Post | Comments Off on Documenting Manifestations: “Connect” with an Accurate Payment
In order to prevent reduced Medicare reimbursements under CMS’ Hospital Readmissions Reduction Program and being penalized under CMS’ Hospital Value-Based Purchasing Program for having high rates of preventable readmissions, the author suggests 10 proven ways hospitals can reduce their number of preventable readmissions:
Read Full Post | Comments Off on What We’re Reading – 10 Ways to Reduce Hospital Readmissions
Great customer service seems like an intuitive thing to most people, but time and time again, businesses do something to alienate a consumer. The old adage that it costs less to keep a customer than to find a new one was never more important than in today’s economy. This quick-read provides some great reminders, from making each customer feel important, like your number-one priority, to valuing complaints and learning to apologize. Sometimes the customer is – well – wrong, but s/he is still the customer; the author suggests you make it easy for people do business with you. Finally, the article reminds us of the internal customers we sometimes take for granted: employees. When employees feel appreciated and valued, they extend the same kindness and respect to customers for a full-circle of benefits.
Suggestion for the week: Check out the 10 Commandments and see how many your business is keeping (and breaking).
Read Full Post | Comments Off on What We’re Reading – The 10 Commandments of Great Customer Service
Home Health Agencies should ask their homecare software vendor if they are ready for the new required software changes for claims submission. All covered entities must submit Medicare electronic claims using X12 version 5010 effective January 1, 2012. If your software vendor is not currently testing or sending production claims in the v5010 format, please review the ANSI 5010 information posted under PalmettoGBA/ANSI5010.
Please contact the Technology Support Center at (866) 749-4301 if you have any questions regarding the v5010 transition.
Don’t risk payment interruption. Transition to v5010 now!
PalmettoGBA/RailroadMedicare/AreYouReadyFor5010
For more tips on Home Health Billing, contact Imark Consulting, Inc.
Read Full Post | Comments Off on Are You Ready for 5010?
Do you think a provider would chart heart disease for a patient with – say – hypertrophic cardiomyopathy because it’s a ‘warmer, fuzzier’ diagnosis? Or try to scare a patient with metabolic disorder into losing weight by diagnosing her prematurely with diabetes? You’re probably shaking your head in disbelief, yet some providers do just this when it comes to charting dependence on a substance, such as alcohol or other drugs. Their ambivalence leads to documentation of ‘use’ or ‘abuse’ as they fear “stigmatizing” the patient with a diagnosis of addiction, and somehow ‘use’ and ‘abuse’ seem less negative.
Clinicians are ethically mandated to use their medical knowledge and judgment to diagnose a patient’s condition and then to chart it completely and accurately. So if our hypothetical provider charts in this fashion, is he, in a sense, committing fraud? Fraud has several definitions: deceit, trickery, sharp practice, or breach of confidence, perpetrated for profit or to gain some unfair or dishonest advantage; any deception, trickery, or humbug.
While soft-pedaling a diagnosis hardly results in profit or gain, it is dishonest, and in keeping with the definition above, deceitful. It begs the question of where exactly is the line between accurate reality and a little white lie. Knowingly charting less than accurately is deceptive and fraudulent.
‘Addiction’ (termed substance dependence by the American Psychiatric Association and coded as 303.xx or 304.xx) is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring anytime in the same 12-month period:
Dependencies are no different from diabetes, or any other condition. We regularly counsel all providers to ensure their documentation and diagnoses reflect the patient’s reality as they perceive it to be, in their medical judgment, and counsel the patient appropriately.
Sources:
DSM-IV-TR Diagnositc Criteria from the American Psychiatric Association
Coders’ Desk Reference, 2010, published by Ingenix
Dictionary.com, accessed on 9/21/11
Although this “article’s” underlying message is the medical practice’s need of a good software program, the seven tips are sound operational activities that transcend software. Checking patient eligibility, timely billing of all visits (including hospital and nursing home rounds), and prompt collection of patient balances – to name a few – make a huge difference to practice profitability. And in just about every case cited, a low-tech option can be designed to accomplish the same objective.
Read Full Post | Comments Off on What We’re Reading: 7 Tips on How to Manage the Medical Office in Tough Economic Times
When a medical group’s risk score is low despite a chronically ill patient population, the culprit is generally one of three very common practitioner habits. Let’s explore each one:
Failure to connect diabetic manifestations: This is probably the low-hanging fruit of the risk adjusted reimbursement world and one that’s relatively easy to fix. Diabetes is known for its devastating effects on the entire body, from the eyes to the kidneys, yet we lose track of the number of diabetics whose manifestations are not properly documented or coded by the provider. Peripheral Neuropathy in a diabetic warrants a more specific diabetes ICD-9-CM code (e.g., 250.6x); not only is this the most accurate code for the patient’s condition but when the patient’s diabetes has caused this neurological manifestation, the funding is adjusted as well. In this case, the missing connection results in decreased funding of $413.52 PMPM*.
Improper documentation of histories. The term ‘history’ is actually used in two manners by clinicians. In one sense, the history of a condition – for example, seizure disorder – can be documented to remind the practitioner that the patient had an episode of this condition in the past. It can also mean the patient has actually had the condition for some time and is receiving treatment. In most cases, this habit of documenting has been honed over time, but not only is it inaccurate, it also impacts the provider’s reimbursement. Practitioners need to understand that coding guidelines dictate that ‘history’ is generally coded as a condition that was successfully treated, no longer exists and is not a health threat to the patient. Using our example above, the ICD-9-CM code for history of seizure disorder is v12.49; the correct code for a patient under treatment for a seizure disorder is 345.9x. The funding difference is $270.61 PMPM* .
Un-specific cardiac disease. According to the American Heart Association, heart disease continues to be a leading cause of morbidity and mortality in the U.S. However, consider this diagnosis a general category – if you will – and one that is not used when more specific acute or chronic manifestations of heart disease are apparent. It’s akin to saying we live in the Milky Way Galaxy as opposed to Miami, Florida. Clinicians are reminded to consider the patient’s accurate cardiac status and document in a way that reflects the active conditions, even if stable and responding to treatment. From a funding standpoint, the difference between documenting the all-general (non-risk-adjusted) cardiac disease, as opposed to the more specific atrial fibrillation or cardiomyopathy is $296.96 PMPM* and $415.54 PMPM*, respectively.
* All funding estimates are based on a 75 year-old, community dwelling female in Dade County.
Read Full Post | Comments Off on The Top Three MRA Mistakes: How much are these costing your practice?